Assessing Time to Surgery in Asian Women With Breast Cancer: A National Cancer Database Analysis.

BACKGROUND AND OBJECTIVES: Time to surgery (TTS) > 60 days is a Commission on Cancer quality metric associated with worse outcomes in breast cancer. Asian American and Pacific Islander (AAPI) women are frequently analyzed in aggregate, obscuring subgroup disparities. We evaluated differences in TTS among AAPI subgroups and their impact on overall survival (OS). METHODS: A retrospective cohort study of AAPI women with breast cancer in the National Cancer Database was performed categorizing patients as East Asian (EA), Southeast Asian (SEA), South Asian (SA), or Pacific Islander (PI). Delayed TTS was defined as surgery > 60 days from diagnosis. Descriptive statistics, log-rank tests, and multivariable Cox regression assessed TTS and OS. RESULTS: Among 72 253 patients (EA 40%, SEA 30%, SA 21%, and PI 8%), SEA women had the highest proportion of TTS > 60 days (29%, p < 0.001). On multivariable analysis, SEA status (HR 0.89; 95% CI 0.88-0.91; HR > 1 indicates shorter TTS), Medicaid insurance (HR 0.76; 95% CI 0.74-0.78), and West South-Central region care (HR 0.87; 95% CI 0.82-0.93;) were associated with longer TTS. Delayed TTS was worse OS among all AAPI groups (p < 0.001). PI women had the worst overall OS among AAPI subgroups (HR 1.45, 95% CI 1.35-1.56). CONCLUSIONS: Disaggregated analyses revealed subgroup disparities, with SEA women experiencing the longest TTS and PI women worse OS.